'Tis been an interesting weekend for trauma in these parts as well. Finally cracked a chest as a Chief Resident. By most accounts, it was the first chest crack here in over two years.

70 year old guy got shot in the box and, according to EMS, lost his vitals on the way in. So we cracked his left chest and, to my surprise, found nothing in the pericardium, heart, or left chest. Extended it across the midline and out laterally to the right chest and found it was filled with blood. Clamped the pulmonary hilum and continued resuscitating. Never got him back, but at least I think we stopped the bleeding in the right chest.

To quote Bill Clinton, I feel your pain. I'm on Q4. Last summer over the span of a couple of weeks I had TWO separate patients come in who in the middle of the night got drunk, took the ATV for a ride, and clotheslined themselves on a barbed-wire fence. And the families both had the audacity to tell me that they wanted Junior to not have any scars on the face that he pretty much shredded in a transverse line at the level of his nose. Sure, folks, that's the magic of Plastic Surgery.

To quote Bill Clinton, I feel your pain. I'm on Q4. Last summer over the span of a couple of weeks I had TWO separate patients come in who in the middle of the night got drunk, took the ATV for a ride, and clotheslined themselves on a barbed-wire fence. And the families both had the audacity to tell me that they wanted Junior to not have any scars on the face that he pretty much shredded in a transverse line at the level of his nose. Sure, folks, that's the magic of Plastic Surgery.

I hate ATVs.

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Same here. Drunk 19 Yo falls off the cliffs next to the college. Is he going to have scars? yep. jack ass. If you don't want to get injured don't get drunk next to cliffs, moron. I hate taking care of drunk *******s...take all of 2 seconds of my rounds, OH! you're in pain? no ****...I like taking care of people that take care of themselves. Im more concerned about the scar i put on the 82 yo chole's lap sites than some 22 yo moron that falls drunk off a cliff. thats a reminder why you shouldn't drink jack ass.

To quote Bill Clinton, I feel your pain. I'm on Q4. Last summer over the span of a couple of weeks I had TWO separate patients come in who in the middle of the night got drunk, took the ATV for a ride, and clotheslined themselves on a barbed-wire fence. And the families both had the audacity to tell me that they wanted Junior to not have any scars on the face that he pretty much shredded in a transverse line at the level of his nose. Sure, folks, that's the magic of Plastic Surgery.

I hate ATVs.

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F*** ATV's. F***ing things should be required to have roll cages and one of those breathalyzer devices so you can't start it unless your BAC is <0.05 or something. I've seen more ATV-related ridiculous **** than I ever thought possible. And I too am a fan of the demand not to have scars no matter what the injury.

I dunno, I see ATVs as a device to help ensure that the Darwin Awards continue.

When I was Chief on Peds Surg, we had two young teenagers come in as Level I ATV vs car. Only one was wearing a helmet (he went home the next day after 23 hr obs for his mild CHI). The other, the driver, needs to go to the OR with Nsgy for evacuation and a ventric placement.

Nsgy resident is shaving his head and sees a huge scar consistent with a previous crani. Come to find out, when the parents arrive, that approximately 2 years earlier, the patient had been injured in a <wait for it> ATV accident in which his older brother was killed (or in persistent veggie state...can't remember).

He survived although with a permanent brain injury requiring 24 hr care. I don't blame him because he was a stupid country bumpkin teenager, but his parents? Sound like contenders for a Darwin Award by proxy.

ech. that sounds horrid. When I was at Ryder my progression went like this:

Never drink and get in/on any vehicle->never get on a motorcycle->never get in a car->never walk across the street->never get out of bed.

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During my month on Ryder, I learned that I shall never own a motorcycle. Here in Miami, just owning a car is dangerous. I live close to campus -- so I always walk in the mornings. For groceries and eating out, I have to take my car. Sure enough, within eight months of living in this dreaded city, I got T-boned at an intersection by an SUV. I lost my car and spent the evening in the emergency department. I think I'm going to move to New York City where I don't have to drive.

ech. that sounds horrid. When I was at Ryder my progression went like this:

Never drink and get in/on any vehicle->never get on a motorcycle->never get in a car->never walk across the street->never get out of bed.

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What I learned at Ryder:

If your are a mentally handicapped teenager in a car with 3 other MR teenagers at 3:00 am and you see a cat in the road:

1)Just hit the d**n cat
2)If you have to swerve to avoid hitting said cat, attempt to do it towards the side with no telephone pole.
3)If you must swerve into the telephone pole atleast hit your breaks.
4)If you are not going to hit your breaks, atleast make sure that everyone is wearing a seatbelt
5)If your passenger refuses to wear a seatbelt, atleast try to carry other passengers who won't scream at the people who are attempting to stabilize your friend in Stage III shock who has 5 broken ribs, a broken vertebrae, a shattered femur, a degloving injury of the entire left arm, numerous lacerations to the face, and is missing most of an ear while she is completely uninjured.

Oh yeah, and if you are selling yourself for crack at 11:00 am, please avoid Johns who tend carry around those nail clipping scissors, because they can apparently be used as a weapon. This was a great experience for me as an MS-3 however, because 30 lacs later, my suturing skills had been elevated above most of fellow classmates.

I don't know what it is about Ryder, but I saw the CRAZIEST stuff there.

I became close friends with one of the trauma surgeons and when I call him at 3am to see what he is up to, his stories are WAAAAAAAAAAAY more interesting than the stuff I see in nyc.

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I think that there are three reasons for the more interesting cases at Ryder:

Number 1 -- gun laws are more relaxed in the state of Florida than they are in New York. Obtaining a weapon is much easier here.

Number 2 -- more people own cars in Miami residents of New York do. We also have lots of immigrants have no idea how to drive. Accidents are occurring all of the time. Just to give you an idea of how bad things are, when I moved to Miami, my car insurance rates doubled.

Number 3 -- Ryder Trauma Center is the only level 1 trauma center for both adults and children in this area. In New York City, I would imagine that there are more hospitals available to more evenly distribute the cases.

That and in NYC, apparantly NO ONE really knows how to shoot or stab anyone. On the one hand, making it a relatively nice place to live. On the other, a crappy one to get really good trauma experience.....Its a hardship to have to spend a month in miami.

I am rarely involved on the front lines of trauma anymore. Last Saturday, however, I was moonlighting in the middle of nowhere in Kentucky. I saw some ridiculous injuries. I had one kid riding an ATV that I treated for pneumonia a week prior. He was still on antibiotics. He had a wooden spike the size of a railroad spike through his shoe and through his foot.

I had two "tubing" injuries. One guy dislocated his shoulder and the other got caught up in the propeller. Ouch.

I also had someone walk in with a shotgun blast to the knee. There was tons of other crazyness all involving alcohol and people with way too much time on their hands.

I swear to god, if I hear anyone say the word "papaw" (prounounced pa like pat and paw like paw) to describe their grandfather again I am going to go postal. I'm sitting in a computer lab and some medicine intern is saying it every other sentance.

I swear to god, if I hear anyone say the word "papaw" (prounounced pa like pat and paw like paw) to describe their grandfather again I am going to go postal. I'm sitting in a computer lab and some medicine intern is saying it every other sentance.

I hate ATV's too. Two weeks ago I admitted two different 80 year olds involved in ATV's accidents. One was a guy with a metal heart valve on coumadin and an ETOH of 140. He told me he normally has no trouble on his ATV but this time he was doing an "experiment" - whatever that means.

I am rarely involved on the front lines of trauma anymore. Last Saturday, however, I was moonlighting in the middle of nowhere in Kentucky. I saw some ridiculous injuries. I had one kid riding an ATV that I treated for pneumonia a week prior. He was still on antibiotics. He had a wooden spike the size of a railroad spike through his shoe and through his foot.

I had two "tubing" injuries. One guy dislocated his shoulder and the other got caught up in the propeller. Ouch.

I also had someone walk in with a shotgun blast to the knee. There was tons of other crazyness all involving alcohol and people with way too much time on their hands.

I swear to god, if I hear anyone say the word "papaw" (prounounced pa like pat and paw like paw) to describe their grandfather again I am going to go postal. I'm sitting in a computer lab and some medicine intern is saying it every other sentance.

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My favorite KY trauma was the 75 y/o drunk papaw who broke L5 after falling out of the lawn chair he was sitting in. In the back of a pickup truck. That was last labor day though, not Memorial day.

Playing the odds, I would not have attempted that in a 70 year old unless I just wanted practice for a salvageable patient (which is actually a valid rationale to me)

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No doubt. We saw an indication and decided to go for it since I needed to pop it and the last time anyone in the ED saw one, Rick Rolling was only beginning to become a big internet phenomenon.

My Chairman criticized me at M&M for not shoving a cannula into the right atrium for resuscitation. Though I had heard of it before, I wasn't about to attempt it with my first (and probably last since I'm now graduated...) chest crack.

I hate ATV's too. Two weeks ago I admitted two different 80 year olds involved in ATV's accidents. One was a guy with a metal heart valve on coumadin and an ETOH of 140. He told me he normally has no trouble on his ATV but this time he was doing an "experiment" - whatever that means.

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If I ruled the world, this patient would automatically get a hospice consult.

My sister-in-law's family goes overboard with the wacky names. Both sides of the family grandma and grandparents have to have unique names (Because God forbid you just call them both Grandma and Grandpa" So yeah, there's a lot of "Pahpaws" and "Gangee" and "Meemees", especially when you add in a lot of great aunts and uncles have the same names. Drives me bonkers It's cute when a little three year old says it, bizarre when a 17 year old does.

The best way to be a victim of random assault & battery is to be hanging out in the streets at 2 AM "minding your own business."

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And then they just come out of nowhere and jump you for "no reason". My favorite part is even though you may have lived next door to the perpetrator your whole life when the cops come it was always "some guy"

First, the serious. Here in South Carolina, last week, two teens - 15 and 13 - killed when ejected in a rollover. The 15 year old - with only a learner's permit - was given the car to get to and from school.

Second, heard a story about a patient who was in a race track MVC (modified small trucks), and just kept saying "****, diddy!" on and on. This got to a story from a nurse as to, when she was dating her later husband, when they were going to visit outside of Charleston, he was talking about his "diddy", and the nurse was trying to determine who 'diddy' was, and she said to him, "Is that your uncle, or a brother, or who?", and he finally said "It's my goddamn father!" I took it as just South Carolina lore, until 2 weeks ago, when a SC State Police trooper said, "My diddy is diabetic". So there's your "pawpaw".

Finally, my canned statement about "those two dudes":

"Do you know what is the most dangerous job in the United States? Is it astronaut, or firefighter, or lumberjack or commercial fisherman? Amateurs. The most dangerous job in the United States is 'minding your own business', as that is what one will be doing when "those two dudes" kick one's ass (as one other person can shoot or stab you, but no one will admit less than 2 people assaulted them unarmed), at 2am. Also, what is the most dangerous route, leading to the most dangerous location, with the most dangerous person? Walking to or from church or the prayer meeting, to end up reading the Bible on the porch with Grandma, when, for no reason, those two dudes came up and kicked your ass. This epidemic of crime is bad and nationwide, as those "two dudes" are wreaking mayhem all over, aided by their close compatriot, 'that bitch'.

When I was a resident, my division chief told me of doing missionary work in a 3rd world ED in Papua New Guinea, when a man walks in with an arrow sticking out out of his back. His story? 'I was walking home from the prayer meeting, minding my own business, when someone shot me in the back with an arrowfor no reason'."

Perhaps. But no, I don't think they would. The US used to have a myriad of regional dialects. Now they exist only on recordings, in stereotypes (i.e. Mayor Quimby & Cletus on the Simpsons), and in a few anachronisms like my pet names for my grandparents.

When radio first became democratized in the 30s, with long-range broadcasting, my grandparents had a lot of difficulty understanding it. New York radio announcers talked like New Yorkers and my grandparents talked like Appalachians. Now there is more or less a Standard American English and we all sound like Californians. Accents still persist, particularly in the South, but dialects have more or less been absorbed.

Even accent wise homogenization is occuring, the Boston "Pahk yah cah on Hahvad Yahd" is recognized to be fading along with some of the other idiosyncrasies of New England speech. Many linguists do in fact attribute this to national media(in the generic sense not the specific news dissemination sense)

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